What is postcholecystectomy syndrome?

William B. Salt II., MD

A Postcholecystectomy syndrome, the most common cause of which is gallstones in the bile duct.

Every year, about 500,000 to 600,000 cholecystectomies are performed in the United States, most commonly using a scope (laparoscopic cholecystectomy). One in ten people who have a cholecystectomy develop symptoms after the surgery, called postcholecystectomy syndrome, or PCS. There are many possible causes of PCS.

When elevated blood levels of bilirubin (hyperbilirubinemia) and amylase (hyperamylasemia) are found, it is important to consider the possibility that there may be one or more gallstones in the bile duct (choledocholithiasis). Bilirubin relates to the bile duct and amylase to the pancreas, and the bile duct and pancreas duct join together when they enter the first part of the small intestine, called the duodenum. So elevations of both bilirubin and amylase raise concern of a bile duct and pancreas problem related to gallstones in the bile duct. 

Gallstones in the bile duct may not be detected at the time of surgery, and they can cause blockage of the bile duct leading to hyperbilirubinemia and yellowing of the eyes, skin, and urine (jaundice) and inflammation of the pancreas (pancreatitis). Abdominal pain is usually present.

Gallstones in the bile duct can usually be removed by a scope procedure passed through the mouth into the duodenum called, ERCP (endoscopic retrograde cholangiopancreatography).

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